Table of Contents

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Volume 38, Number 4

December 2006

Drug-Abusing Women in Sweden: Marginalization, Social Exclusion and Gender Differences — Siv Byqvist, Ph.D.

Gender, Mental Health, and Treatment Motivation in a Drug Court Setting — J. Matthew Webster, Ph.D.; Paul J. Rosen, M.S.; Jennifer Krietemeyer; Allison Mateyoke-Scrivner, M.S.; Michele Staton-Tindall, Ph.D. & Carl Leukefeld, D.S.W.

Integrated Cognitive Behavioral Therapy Versus Twelve-Step Facilitation Therapy for Substance-Dependent Adults with Depressive Disorders — Sandra A. Brown, Ph.D.; Suzette V. Glasner-Edwards, Ph.D.; Susan R. Tate, Ph.D.;  John R. McQuaid, Ph.D.; John Chalekian, M.S. & Eric Granholm, Ph.D.

Perspectives on Therapeutic Treatment from Adolescent Probationers — Ricky N. Bluthenthal, Ph.D.; Kara Riehman, Ph.D.;  Lisa H. Jaycox, Ph.D. & Andrew Morral, Ph.D.

Relating Substance Abuse Counselor Background to the Provision of Clinical Tasks — Jeffrey R.W. Knudsen, M.A.; Steven L. Gallon, Ph.D. & Roy M. Gabriel, Ph.D.

Novice, Seasoned and Veteran Counselors’ Views of Addiction Treatment Manuals: The Influence of Counselor Characteristics on Manual Usefulness — Lori Simons, Ph.D.; Raymond Jacobucci, M.Ed. & Hank Houston, B.A.

Bread of Heaven or Wines of Light: Entheogenic Legacies and Esoteric Cosmologies — Frederick R. Dannaway; Alan Piper & Peter Webster

Single Dose of 24 Milligrams of Buprenorphine for Heroin Detoxification: An Open-label Study of Five Inpatients — Kathleen Ang-Lee, M.D.; Michael R. Oreskovich, M.D.; Andrew J. Saxon, M.D.; Craig Jaffe, M.D.;  Charles Meredith, M.D.; Mei Ling K. Ellis; Carol A. Malte & Patricia C. Knox, Ph.D.

Methadone Death, Dosage and Torsade de Pointes: Risk-Benefit Policy Implications — Mark Latowsky, M.D.

The Magistrates Early Referral into Treatment (MERIT) Pilot Program: A Descriptive Analysis of a Court Diversion Program in Rural Australia — Megan Passey, B.Med. (Hons), M.P.H., S.M.; Bruce Flaherty, B.A. (Hons) Dip Urb Stud, Ph.D.  & Peter Didcott, B.A., Dip Crim

SHORT COMMUNICATION

Recovery and Spiritual Transformation Among Peer Leaders of a Modified Methadone Anonymous Group — Linda Glickman, Ph.D.; Marc Galanter, M.D.; Helen Dermatis, Ph.D. & Shannon Dingle,  B.A.

PUBLISHER’S NOTE -- An Upper/Downer Perfect Storm: The Coming World-Wide Drug Epidemic — David E. Smith, M.D.

INDEX — Volume 38 (1-4) 2006

COVER ART - Cling Vines and Shadows by Kay Carlson (www.kaycarlson.com)

Abstracts

Gender, Mental Health, and Treatment Motivation in a Drug Court Setting— J. Matthew Webster, Ph.D.; Paul J. Rosen, M.S.; Jennifer Krietemeyer; Allison Mateyoke-Scrivner, M.S.; Michele Staton-Tindall, Ph.D. & Carl Leukefeld, D.S.W.
Abstract—The current study examined differences in motivation for drug treatment in a sample of 500 (327 males and 173 females) drug court participants. It was hypothesized that females would report higher levels of treatment motivation, as indicated by measures of problem recognition and desire for help, and that this difference would be moderated by mental health. After controlling for selected factors related to treatment motivation, females were found to have higher levels of problem recognition and desire for help. A significant gender x mental health interaction was also found, suggesting that females with more mental health problems have the highest levels of desire for help.
Keywords—drug court, gender, mental health, treatment motivation

Integrated Cognitive Behavioral Therapy Versus Twelve-Step Facilitation Therapy for Substance-Dependent Adults with Depressive Disorders — Sandra A. Brown, Ph.D.; Suzette V. Glasner-Edwards, Ph.D.; Susan R. Tate, Ph.D.; John R. McQuaid, Ph.D.; John Chalekian, M.S. & Eric Granholm, Ph.D.
Abstract—In a randomized trial, this study compared the longitudinal outcome patterns of veterans (N = 66) with substance use disorders and major depressive disorder receiving standard pharmacotherapy and either 12-Step Facilitation Therapy (TSF) or disorder-specific Integrated Cognitive Behavioral Treatment (ICBT). Depression and substance use were assessed at intake, during and after treatment using the Hamilton Depression Rating Scale and the Time Line Follow Back. Reductions in depression during treatment were comparable between the two treatment groups; however, their posttreatment patterns were distinct. While ICBT participants evidenced a steady linear decline in depression through six months posttreatment, a quadratic trend characterized TSF participants, for whom depression declined during treatment, but increased throughout posttreatment follow-up. During treatment, TSF participants used substances less frequently relative to those in ICBT; however, reductions in substance use were more stable through six months posttreatment among those in ICBT relative to TSF. While both interventions produced improvement in depression and substance use during treatment, ICBT may yield more stable clinical outcomes once treatment ceases.
Keywords—behavioral interventions, cognitive behavioral therapy, comorbidity, Twelve Step facilitation

Perspectives on Therapeutic Treatment from Adolescent Probationers — Ricky N. Bluthenthal, Ph.D.; Kara Riehman, Ph.D.; Lisa H. Jaycox, Ph.D. & Andrew Morral, Ph.D.
Abstract—Little is known about youths’ experiences in residential adolescent treatment programs. To better understand the experiences of youth in such programs, the authors conducted a longitudinal qualitative study of 10 juvenile probationers in an adolescent therapeutic community (TC) treatment setting. Seven boys and three girls were recruited into the study upon their entry into the TC. Ages ranged from 14 to 17 years old; six youths were Hispanic, three were White, and one was African-American. Each participant completed between two and six audio-recorded interviews over the course of two years. We report on youth experiences in the TC as well as after discharge or drop out. Three issues were most salient in these interviews—the positive and negative influence of peers, youth appreciation of the family counseling component, and the need for improved methods to prevent running away from the program. Regarding running away, half of the youth in our sample who ran away regretted it, suggesting that with more focused intervention some of them might have been retained in the program.
Keywords— drop out, probation, residential drug treatment, retention, substance use, youth

Relating Substance Abuse Counselor Background to the Provision of Clinical Tasks — Jeffrey R.W. Knudsen, M.A.; Steven L. Gallon, Ph.D. & Roy M. Gabriel, Ph.D.
Abstract—This study examines the diverse academic and professional background characteristics of substance abuse treatment counselors, relating these characteristics to the work counselors are doing. Results indicate that while academic and professional background characteristics differentiate whether counselors perform certain clinical tasks or not, they do not differentiate the amount of time they spend doing them. In fact, regression analyses indicate that academic and professional background characteristics currently account for less than 10% of the total variability associated with how counselors spend their time. While meager, the best predictors of individual work tasks appear to be more contextual in nature. The fact that academic and professional background characteristics do not differentiate counselors in terms of time spent on specific clinical responsibilities raises some questions regarding the quality of client care. Results also indicate that the knowledge and skill sets needed for counselors to be effective may vary according to the treatment setting.
Keywords—certification, client care, counselors, substance abuse treatment, workforce

Novice, Seasoned and Veteran Counselors’ Views of Addiction Treatment Manuals: The Influence of Counselor Characteristics on Manual Usefulness — Lori Simons, Ph.D.; Raymond Jacobucci, M.Ed. & Hank Houston, B.A.
Abstract—A preliminary study was conducted to examine substance abuse counselors’ views of empirically supported treatments (ESTs). A survey of 72 substance abuse counselors was used to explore counselor qualities and overall responses to ESTs. There were no significant differences in views of ESTs for novice, seasoned and veteran counselors, but veteran counselors reported that supervision was less likely to influence their views of manual usefulness. Counselors’ recovery status and theoretical orientation influenced novice, seasoned and veteran counselors’ views of ESTs and manual usefulness. Implications for undergraduate, graduate and continuing education are discussed.
Keywords—ESTs’ usefulness, manual treatment attitudes, substance abuse counselors

Bread of Heaven or Wines of Light: Entheogenic Legacies and Esoteric Cosmologies — Frederick R. Dannaway; Alan Piper & Peter Webster
Abstract—This is an article in two parts. The first part discusses current research in psychoactive preparations of ergot in various religious systems with a particular emphasis on Persian, Greek, Jewish and Islamic sources. Certain poems, hadith, and scriptural writings suggest an entheogenic heritage to various ancient sects that exerted and received philosophical and ritual influences over large distances and over time. Particularly, some esoteric Shia and Sufi writings are highly suggestive of a “celestial botany” that employed psychoactive plants for initiatory and ritual purposes. The second part will address current research methods that render ergot alkaloids nontoxic and entheogenic, a most crucial part of the discussion in the absence of a modern bioassay. This is essential, as without a chemical reality to support that such a preparation of entheogenic ergot is possible, all ergot theories concerning mystery traditions would remain largely speculative.
Keywords—entheogens, ergot, Islam, Shia, Sufi

Single Dose of 24 Milligrams of Buprenorphine for Heroin Detoxification: An Open-label Study of Five Inpatients —Kathleen Ang-Lee, M.D.; Michael R. Oreskovich, M.D.; Andrew J. Saxon, M.D.; Craig Jaffe, M.D.; Charles Meredith, M.D.; Mei Ling K. Ellis; Carol A. Malte & Patricia C. Knox, Ph.D.
Abstract—Previous studies indicate that buprenorphine has efficacy in medically supervised opioid withdrawal, but the optimal dosing for maximum tolerability and ease of administration remains undetermined. Five heroin-dependent individuals entered this open-label study of inpatient detoxification with a single 24mg dose of buprenorphine. The mean Clinical Opiate Withdrawal Scale (COWS) score prior to buprenorphine administration was 17.6 (SD = 3.36). COWS scores declined significantly thereafter. There was one episode of precipitated withdrawal that resolved within four hours. Use of ancillary medications was minimal. This study suggests that a single high dose of buprenorphine can be used safely and effectively for inpatient detoxification.
Keywords—buprenorphine, clinical trial, detoxification, opioid dependence, opioid withdrawal

Methadone Death, Dosage and Torsade de Pointes: Risk-Benefit Policy Implications — Mark Latowsky, M.D.
Abstract—Methadone maintenance treatment (MMT) for opioid dependency has consistently shown important heath, social and legal benefits. What started as a small experimental program in Lexington, Kentucky has grown and expanded substantially over 35 years. Its practice is now well established both in specialized centers and in the broader community. In society, methadone deaths represent an important issue of public safety: methadone diversion to and ingestion by nontolerant individuals outside of treatment. Within treatment, methadone deaths occur most commonly in the early stabilization period (due to issue of tolerance), in periods of transition, or among certain individuals who abuse other substances (opioids, benzodiazepines, or alcohol). Research suggests moderately high methadone dosages help improve patient retention. Results from pharmacodynamic, kinetic and stereospecific studies continue to support the importance of individualizing dose. For some patients, much larger doses may be necessary to fully achieve all pharmacotherapy goals of treatment. Practitioners must be cautious however as certain patients on higher dosages are predisposed to torsade de pointes and increased mortality. Policymakers have a responsibility in their decision-making to balance the quality of life benefits for patients within MMT with the risks of increased mortality both for individuals within treatment and the general public.
Keywords—dose, methadone, mortality, policy, torsade de pointes

The Magistrates Early Referral into Treatment (MERIT) Pilot Program: A Descriptive Analysis of a Court Diversion Program in Rural Australia — Megan Passey, B.Med. (Hons), M.P.H., S.M.; Bruce Flaherty, B.A. (Hons) Dip Urb Stud, Ph.D. & Peter Didcott, B.A., Dip Crim
Abstract—There has been a rapid expansion of drugs courts and diversion programs in Western countries, with the aim of diverting drug offenders into treatment. This study presents data from a rural pre-plea court-based diversion into treatment program for adult defendants appearing at a Local (Magistrate’s) Court who have significant illicit drug problems. Unusual features include the intended duration of treatment (three months), and the emphasis on specialised caseworkers, who provide case management services, intensive individual counseling and group therapy sessions, and attend court, providing detailed legal reports. In the first two years, 238 participants were recruited to 266 program episodes. The participants were mostly recidivist offenders, with 61% having been previously imprisoned, and 85% having at least one prior conviction. Half the participants completed the program. Characteristics significantly associated with program completion were principal drug of concern (heroin/amphetamines vs. cannabis/other, OR = 0.4 [95% CI: 0.2, 0.7]), Aboriginality (Aboriginal vs. not, OR = 0.4 [95% CI: 0.2, 0.9]) and accommodation (privately owned vs. other, OR = 2.5 [95%CI: 1.3, 4.7]). Participants identified the caseworker support as the most important element of the program. We conclude that the program was successfully implemented, and that adequately supported skilled caseworkers were critical to its success.
Keywords—drug court, drug crime diversion programs, evaluation, rural, substance abuse

SHORT COMMUNICATION

Recovery and Spiritual Transformation Among Peer Leaders of a Modified Methadone Anonymous Group — Linda Glickman, Ph.D.; Marc Galanter, M.D.; Helen Dermatis, Ph.D. & Shannon Dingle, B.A.
Abstract—This analysis of five recovery narratives from leaders of a peer-led, 12-Step-based self- help group in a methadone treatment program highlights the importance of spiritually-mediated role transformation in the recovery process. For these men and women in their forties and fifties, their progression to a leadership role helping others with their recovery validated the spiritual transformation they regarded as underlying their own recovery process. Assumption of this new leadership/helper role marked a tangible sign that their deepened spirituality allowed them to assume a new, higher function in a struggle with the addiction that had plagued their lives. For these peer leaders, methadone was at the core of the group experience and an aid to spiritual transformation.
Keywords—12-Step groups, methadone anonymous, methadone maintenance, recovery narratives, spirituality